Using Community-based Participatory Action Research to Optimize Clinical Teaching in Baccalaureate Nursing Education in Ghana

Nursing education facilitates the preparation of professional nurses who contribute to population health within a society. The provision of meaningful supervised clinical practice, an important component of nursing education, is a worldwide challenge that needs to be context specific in relation to health needs, nursing roles, and availability of human, fiscal, and clinical resources. A 2010 study of preceptorship as a clinical teaching model in nursing education in Ghana revealed weaknesses, and led to a four-cycled community-based participatory research (CBPR) study, that engaged stakeholders in a process to ascertain the strengths and weaknesses of the current model(s) of clinical education in one undergraduate baccalaureate nursing program in Ghana. Findings offer strategies to enhance clinical teaching effectiveness that would meet or surpass national standards and be feasible within current and potential resources. Data collection commenced in 2016 and included external and internal stakeholders in a process of identifying issues and needs. Working with a four-member local Collaborative Research Team, Cycle One survey data revealed: stakeholder support for the CBPR initiative, need for effective clinical supervision for patient safety and to build students’ competencies, inadequate clinical equipment, meaningless clinical evaluation practices, environments not conducive to teaching and learning, insufficient collaboration between academic and clinical settings, and excessive travel times for clinical practice opportunities. Individual and focus group interviews in Cycle Two provided greater detail about the initial findings and sought suggestions for a way forward. Cycle Two also involved presentations on Cycle One findings, the process of CBPR, and an overview of eight potential clinical teaching models used for clinical education of nurses. A decision to focus on reconceptualization of preceptorship was made and Cycle Three involved creation of a vision and strategies for change. Potential strategic initiatives included: central planning; faculty planning and development; same shift for preceptors and students; focus on relationships, defined roles, and responsibilities of preceptors, nursing staff, clinical faculty, student peers, and students; clear clinical objectives and evaluation criteria and process; and, preceptor appreciation. Cycle Four, completed in 2018, involved validation of the utility of the recommended strategic initiatives with internal and external stakeholders and discussion of where the implementation of changes could start. Overall, this dissertation demonstrated the merit of using the collaborative and cyclical processes involved in CBPR to engage stakeholders in identifying issues in clinical education, promote collective decision-making, and partner across different interest groups in developing a vision and subsequent strategies for change. The CBPR initiative also served a capacity-building function. Stakeholders, particularly the Collaborative Research Team members, gained practical experience with CBPR. Knowledge of potential approaches to clinical nursing education expanded across stakeholder groups, leadership skills were further developed and practiced, and my understanding of the application of change theory was enhanced.